We identified 143 patients undergoing RASP for BPH ≥ 80 g on pre-operative imaging, of which 55 (38.5%) patients continued perioperative aspirin therapy and 88 (61.5%) patients were not taking aspirin. Baseline and peri-operative characteristics of the entire cohort of patients receiving RASP are shown in Table 1. Demographics were similar between patients with continued aspirin and patients never on aspirin including age (70.9 vs 69.2 years, p = 0.15) and BMI (28.6 vs 27.6 kg/m2, p = 0.20). Rates of hypertension (74.5% vs 58.0%, p = 0.04) and cardiovascular disease (30.9% vs 11.4%, p = 0.007) were higher in the continued aspirin group. Preoperative PSA (10.3 vs 9.1 ng/dL, p = 0.50) and prostate volume (152.1 vs 141.3 g, p = 0.25) were also similar between the groups as were rates of prior prostate biopsy (63.6% vs 61.4%, p = 0.86), prior prostate surgery (16.4% vs 21.6%, p = 0.52), and patients on 5ARI (85.5% vs 85.2%, p = 0.48). Mean preoperative hemoglobin (13.8 vs 14.1 g/dL, p = 0.23), postoperative hemoglobin (11.9 vs 12.4 g/dL, p = 0.07), percent change in hemoglobin (13.4% vs 13.2%, p = 0.94), and blood transfusion rate (3.6 vs 1.1, p = 0.56) were not different between the two groups. Specimen weight (102.2 vs 99.9 g, p = 0.87), operative duration (163.6 vs 173.8 min, p = 0.07), and length of stay (2 vs 2 d, p = 0.62) were also no different between the groups. Patients continuing aspirin therapy did not have a higher transfusion rate (3.6% vs 1.1%, p = 0.56) or higher major postoperative complication rates (7.3% vs 3.4%; p = 0.43).
Table 1
Baseline patient characteristics and perioperative variables of patients undergoing robot-assisted laparoscopic simple prostatectomy comparing patients taking 81mg aspirin and those never taking 81mg aspirin.
Variable | Aspirin (n = 55) | Non-Aspirin (n = 88) | p-value |
Baseline |
Age, mean (SD), years | 70.9 (6.2) | 69.2 (7.2) | 0.15 |
BMI, mean (SD), kg/m2 | 28.6 (5.0) | 27.6 (4.2) | 0.20 |
Preoperative Hgb, mean (SD), g/dL | 13.8 (1.7) | 14.1 (1.5) | 0.23 |
PSA, mean (SD), ng/dL | 10.3 (8.7) | 9.1 (6.8) | 0.50 |
Preoperative Prostate Size, mean (SD), g | 152.1 (71.5) | 141.3 (63.2) | 0.25 |
Preoperative Prostate Biopsy, n (%) | 35 (63.6) | 54 (61.4) | 0.86 |
Prior prostate surgery for BPH, n (%) | 9 (16.4) | 19 (21.6) | 0.52 |
Prior alpha blockers therapy, n (%) | 47 (85.5) | 75 (85.2) | 1.00 |
Prior 5-ARI therapy, n (%) | 36 (65.5) | 52 (59.1) | 0.48 |
Comorbidities | | | |
DM, n (%) | 13 (23.6) | 19 (21.6) | 0.83 |
HTN, n (%) | 41 (74.5) | 51 (58.0) | 0.04 |
CAD, n (%) | 17 (30.9) | 10 (11.4) | 0.007 |
CVD, n (%) | 0 (0) | 1 (1.1) | 1.00 |
Simultaneous Bladder Surgery | | | |
Bladder Stone Removal, n (%) | 4 (7.3) | 14 (15.9) | 0.19 |
Bladder Diverticulectomy, n (%) | 2 (3.6) | 4 (4.6) | 1.00 |
Peri-operative |
Specimen Weight, mean (SD), g | 102.2 (56.6) | 99.9 (54.0) | 0.87 |
Operative Time, mean (SD) min | 163.6 (47.6) | 173.8 (51.0) | 0.07 |
Estimated blood loss, median (IQR), cc | 150 [100–200] | 150 [100–200] | 0.35 |
Post-operative Hgb, mean (SD), g/dL | 11.9 (1.8) | 12.4 (1.5) | 0.09 |
Percentage drop in Hgb, mean (SD), % | 13.4 (7.1) | 13.2 (6.4) | 0.94 |
Transfusion requirement rate, n (%) | 2 (3.6) | 1 (1.1) | 0.56 |
Incidental prostate cancer final pathology, n (%) | 10 (18.2) | 13 (14.8) | 0.64 |
Overall Complication, n (%) | 10 (18.2) | 9 (10.2) | 0.17 |
≥ grade 3 [major] Clavien-Dindo Complications, n (%) | 4 (7.3) | 3 (3.4) | 0.43 |
Length of Hospital Stay, median (IQR), d | 2 [1–2] | 2 [1–2] | 0.62 |
BMI: body mass index, PSA: prostate specific antigen, BPH: benign prostatic hyperplasia, 5ARI: 5-alpha reductase inhibitor, DM: diabetes mellitus, HTN: hypertension, CAD: coronary artery disease, CVD: cerebrovascular disease, Hgb: hemoglobin. |
Univariate linear regression analysis was used to determine the impact of any given variable on operative blood loss (Table 2). None of the variables including antithrombotic medications (OR: 0.63, 95% CI:0.33–1.20, p = 0.16), continued perioperative aspirin (OR: 0.62, 95% CI: 0.31–1.25, p = 0.18), prior prostate biopsy (OR: 1.84, 95% CI: 0.95–3.55, p = 0.07), prostate volume (OR: 1.00, 95% CI: 0.99–1.04, p = 0.23), prior BPH surgery (OR: 0.68, 95% CI: 0.30–1.55, p = 0.36), prior alpha blocker therapy (OR: 1.14, 95% CI: 0.48–2.73, p = 0.76), prior 5ARI therapy (OR: 0.98, 95% CI: 0.50–1.88, p = 0.95), operative time (OR: 1.00, 95% CI: 0.99–1.01, p = 0.40), and specimen weight (OR: 1.02, 95% CI: 0.84–1.23, p = 0.83) were found to be associated with increased blood loss. Additionally, none of the comorbidities assessed including Diabetes Mellitus (OR: 1.24, 95% CI: 0.58–2.67, p = 0.70), hypertension (OR: 1.16, 95% CI: 0.60–2.25, p = 0.73), cardiovascular disease (OR: 1.26, 95% CI: 0.59–2.66, p = 0.57), or cerebrovascular disease (OR: 1.34, 95% CI: 0.08–1.88, p = 0.87) were associated with increased blood loss. Finally, no increased blood loss was associated with simultaneous bladder surgery including bladder stone removal (OR: 1.23, 95% CI: 0.47–3.23, p = 0.66) or diverticulectomy (OR: 0.66, 95% CI: 0.11–3.71, p = 0.63).
Table 2
Univariate analysis of factors related to blood loss during robot-assisted laparoscopic simple prostatectomy.
Variable | OR | 95% CI | p-value |
Antithrombotic medications | 0.63 | 0.33–1.20 | 0.16 |
Continued Aspirin (peri-operatively) | 0.62 | 0.31–1.25 | 0.18 |
Prior Prostate Biopsy | 1.84 | 0.95–3.55 | 0.07 |
Pre-operative prostate volume | 1.00 | 0.99–1.04 | 0.23 |
Prior surgery for BPH | 0.68 | 0.30–1.55 | 0.36 |
Comorbidities | | | |
Diabetes Mellitus | 1.24 | 0.58–2.67 | 0.70 |
Hypertension | 1.16 | 0.60–2.25 | 0.73 |
Cardiovascular Disease | 1.26 | 0.59–2.66 | 0.57 |
Cerebrovascular Disease | 1.34 | 0.08–21.86 | 0.87 |
Prior alpha blocker therapy | 1.14 | 0.48–2.73 | 0.76 |
Prior 5ARI therapy | 0.98 | 0.50–1.88 | 0.95 |
Simultaneous Bladder Surgery | | | |
Bladder Stone Removal | 1.23 | 0.47–3.23 | 0.66 |
Diverticulectomy | 0.66 | 0.11–3.71 | 0.63 |
Operative Time | 1.00 | 0.99–1.01 | 0.40 |
Specimen weight | 1.02 | 0.84–1.23 | 0.83 |
BPH: benign prostatic hyperplasia, 5ARI: 5-alpha reductase inhibitor. |